Methotrexate

[Beth53]

Have been taking 25 methotrexate for about 2 months and my liver values are all high. My rheumatologist wants to drop to 12.5 but previously I was having pain on 20. Has anyone had this issue and will the liver test improve with dropping to just 20. I am also on entyvio infusion every 8 was if that makes any difference. Thanks I'm at a loss and don't want to lose any ground I've made 😔

[Paulajolo]

Hi Beth you don't say how long you have had RA. Has your Rhumy suggested steroid injection or prednisolone.

[AbbeyRoad]

Are you taking pills or are you injecting? If you are taking Methotrexate pills, switch to injections. It's easy to do and it won't bother your liver.

[nomoreheels]

I was in a similar situation the first year I was on MTX (tablets) when disease activity determined that my dose was increased from 15mg to 20mg but with the extra 5mg my liver results rose too high. I went back down to 15mg which was enough to show an improvement but it wasn't enough to keep the disease in check. This was when I was moved on to injections, again 20mg, but my liver objected again so back down to 15mg I went. This time both my LFT & inflammation levels were fine as with subcutaneous MTX the bioavailability is higher, less of the med is lost as it doesn't go through the digestive system.

I would think as your Rheumy recommends a half-dose reduction he's concerned that in order to show a downward turn you need a greater reduction than I did. As MTX has a relatively short half-life it's eliminated pretty quickly so I would think by reducing your dose by half & if it's due to the MTX by your next blood test you should show a downward turn. If any of your other meds are also eliminated hepatically that could also have an impact on your LFT's but as your Rheumy is reducing your MTX he obviously suspects it's this causing your rise in levels.

The liver is a clever organ, it is able to repair itself so I wouldn't worry too much just now. There are things we can do to help it too, limit alcohol or avoid if your Rheumy recommends until your results are better & increasing the amount of water you drink is very helpful if you're not doing so already.

[Beth53]

I do take injection and have done so for over a year my dr increased the meth dosage from 20 to 25 because of my high inflammation rates and have been on 25 for 2 months and did feel better. I talked her into dropping my dosage only back to 20,do you think this will be enough I'm afraid of going backwards to the pain and other illness. I do have ulcerative colitis which was severe but much better now thanks to entyvio and apriso and was told they wouldn't affect the liver. I'm feeling helpless and suggestion are appreciated.

[Radiogirl]

We walk a tight rope, don't we. Sure hope your rheumy can give you what you need safely. Hugs!